<!DOCTYPE html>
<html>

	<head>
		<meta charset="UTF-8">
		<title></title>
		<link rel="stylesheet" type="text/css" href="../stylesheets/main.css" />
		<script src="http://g.tbcdn.cn/mtb/lib-flexible/0.3.2/??flexible_css.js,flexible.js"></script>
		<script src="http://apps.bdimg.com/libs/jquery/2.1.4/jquery.min.js"></script>
		<style type="text/css">
			input {
				border: none;
			}
		</style>
	</head>

	<body>
		<!--头部导航-->
		<header class="">
			<a class="back"></a>
			<div class="title">标题</div>
		</header>
		<div class=" fz28 bdb bg-white mt15 txt-ellipsis">
			<div class=" bdb hht60 pr ">
				<label class="ml20">添加挂号人</label>
				<a class="dp-inlb icon-iconfont-jiahao h fr pr50" href="常用挂号人.html"></a>
			</div>
			<div class="ml20 fz28 hht70 bdb txt-ellipsis">
				<label class="fc-grey">姓&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;名：</label>
				<input type="text" name="" id="" value="" placeholder="请输入姓名" />
			</div>

			<div class="ml20 fz28 hht70 bdb txt-ellipsis">
				<label class="fc-grey">身&nbsp;份&nbsp;证：</label>
				<input type="text" name="" id="" value="" placeholder="请输入身份证号" />
			</div>
			<div class="ml20 fz28 hht70 txt-ellipsis">
				<label class="fc-grey">手&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;机：</label>
				<input type="text" name="" id="" value="" placeholder="请输入手机号" />
			</div>
			<div class="ml20 fz28 hht70 bdt txt-ellipsis">
				<label class="fc-grey">卡&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;号：</label>
				<input type="text" name="" id="" value="" placeholder="请输入卡号" />
			</div>
			<div class="ptb10 ml20 fz28 bdt txt-ellipsis">
				<label class="fc-grey">就诊类型：</label>
				<span class="dp-inlb hht50 tc w110 bg-ccc fc-white fz26">市民卡</span>
				<span class="dp-inlb hht50 tc w110 bg-cyan fc-white fz26">医保卡</span>
			</div>
		</div>

		<h1><a href="挂号成功.html"><div class="hht88 bg-white mt15 fz30 fc-cyan tc bdtb">
			提交
		</div></a></h1>
	</body>

</html>